Abstract 9737: Cardiovascular Abnormalities Associated With In-hospital Mortality in Patients With Spontaneous Subarachnoid Hemorrhage

Abstract

Introduction: Neuro-cardiogenic syndrome is frequently encountered in patients with spontaneous subarachnoid hemorrhage (SAH) resulting in a wide spectrum of cardiovascular abnormalities. However, little information is known regarding the prognostic implications of these abnormalities in patients with spontaneous SAH. Objectives: To determine the cardiovascular abnormalities that correlate best with in-hospital mortality in patients with spontaneous SAH. Methods: All patients admitted to our institution with a primary diagnosis of SAH, and underwent a transthoracic echocardiogram (TTE) from July 2011 until May 2014 were enrolled. Data gathered included patients' demographics, troponin T level, electrocardiographic (ECG) changes, TTE findings, and in-hospital mortality. Multivariate logistic regression to quantify the relationship between cardiovascular abnormalities and in-hospital mortality was performed. Results: 247 patients were included in the analysis. The mean age of patients was 59 years. 66% of the patients were females. The incidence of in-hospital mortality was 15.6%. The presence of resting segmental wall motion abnormalities on TTE (odds ratio (OR)=2.7, 95% confidence interval (CI) 1.19-6.01, p=0.03), ejection fraction ≤ 35% (OR=3.6, 95% CI 1.24-10.52, p=0.03), positive troponin level (OR=3.0, 95% CI 1.17-7.55, p=0.03), and QTc prolongation on ECG (OR=5.4, 95% CI 1.77-16.29, p<0.005) were associated with increased risk of in-hospital mortality on univariate analysis. On multivariate logistic regression, QTc prolongation was the only independent predictor for in-hospital mortality (OR=5.13, 95% CI 1.04-25.28, p=0.04). Conclusions: Among the variable cardiovascular abnormalities seen in patients with spontaneous SAH, prolonged QTc interval on ECG was independently associated with in-hospital mortality. It is unknown whether this is a causative association or a marker of underlying severe clinical presentation of spontaneous SAH.